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More research needed on antipsychotic treatment in adolescents with bipolar disorder
Patient-centered research on the safety and efficacy of antipsychotic medications in adolescents and young adults with bipolar disorder is needed, according to the Duke Evidence Synthesis Group. The group was tasked by the Patient-Centered Outcomes Research Institute to create a prioritized agenda for research about the advantages and disadvantages of antipsychotic medication use in this patient population.
The group found 23 potential evidence gaps, which they outlined in a study published in Annals of Internal Medicine.
About 2.7% of people aged 12 to 21 years have bipolar disorder, which increases to about 5% accounting for those with manic symptoms who are at a higher risk for illness, according to the group. Recovery is possible in many adolescents with bipolar disorder, but 80% relapse within 2 to 5 years. More evidence of current treatment programs is necessary to combat the alarmingly high rate of relapse, they wrote.
Matthew J. Crowley
Matthew J. Crowley, MD, of the Durham Veterans Affairs Medical Center, and colleagues reviewed literature published from 2008 to 2013 that focused on systematic reviews, particularly reports that identified future research needs for antipsychotic treatment of bipolar disorder among adolescents. The research group consulted clinical experts and researchers in bipolar disorder and representatives of federal and nonfederal funding agencies regarding evidence gaps they found based on past research goals.
Researchers categorized the top tier of issues into three categories. First, uncertainty about the use of specific intervention strategies for bipolar disorder among adolescents should be further researched. Issues in this category include: the safety and effectiveness of monotherapy with antipsychotics vs. combination therapy with mood-stabilizing medications, psychiatric medications other than mood stabilizers, and the use of antipsychotics alone vs. combined with nonpharmacologic treatments. Second, future research should resolve uncertainty surrounding the effects of antipsychotics on social, academic and occupational functioning. Finally, current research should address how patient factors may affect the use of antipsychotics in adolescents with bipolar disorder.
“Treatment of bipolar disorder with antipsychotic medications among adolescent and young adults is increasing, but the evidence base supporting the patient-centered comparative effectiveness and safety of these medications has not kept pace. In order for patients, providers, and other stakeholders to make informed decisions, new patient-centered research is needed,” Crowley and colleagues concluded.
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